Mask-Associated Dry Eye (MADE) in healthcare professionals working at COVID-19 pandemic clinics

Background: Healthcare professionals working at COVID-19 pandemic clinics have to work with masks during long hours. After the widespread use of masks in the community, many mask-related side effects were reported to clinics. The increase in the number of applicants with dry eye symptoms due to mask use in ophthalmology clinics has led to the emergence of the concept of mask-associated dry eye (MADE). We think that it would be valuable to evaluate ocular surface tests with a comparative study using healthcare professionals working in pandemic clinics, which we think is the right study group to examine the effects of long-term mask use. Aims: We aimed to evaluate the mask-associated dry eye (MADE) symptoms and findings in healthcare professionals who have to work prolonged time with face masks in coronavirus disease 2019 (COVID-19) pandemic clinics. Patients and Methods: In this prospective, observational comparative clinical study, healthcare professionals who use the mask for a long time and work in COVID-19 pandemic clinics were compared with an age and sex-matched control group consisting of short-term masks users, from April 2021 to November 2021. All participants underwent the Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (T-BUT), Oxford staining score, Schirmer's test I, and meibography with infrared transillumination. Results: The long-term mask user group consisted of 64 people, while the short-term mask user group consisted of 66 people (260 eyes, total). The OSDI score and Schirmer I measurement were not statistically different between the two groups. T-BUT was statistically significantly shorter in the long-term group (P: 0.008); lid parallel-conjunctival fold, Oxford staining score, and upper and lower lid meibography score were found to be significantly higher in the long-term group (P < 0.001, P: 0.004, P: 0.049, P: 0.044, respectively). Conclusion: Healthcare professionals with longer mask-wearing times are at greater risk of ocular surface damage. It may be considered to prevent this damage by blocking airflow to the ocular surface, such as by wearing a face mask properly or fitting it over the nose with surgical tape. Those who have to work with a mask for a long time during the COVID-19 pandemic should keep in mind the ophthalmology follow-up for eye comfort and ocular surface health

EVALUATION OF THE ASSOCIATION OF PIGMENTARY MACULOPATHY IN PRIMARY BLADDER PAIN SYNDROME PATIENTS RECEIVING PENTOSAN POLYSULFATE SODIUM TREATMENT

Objective Primary bladder pain syndrome (PBPS) is characterized with suprapubic pain accompanied by at least one lower urinary tract symptoms including frequent urination, urinary urgency and nocturia for more than 6 weeks. While there are many alternative therapies for the treatment of PBPS, the only approved oral medication is PPS (pentosan polysulfate sodium). As it has been associated with retinal toxicity after its widespread use, this study aims to evaluate the relationship between PPS use and maculopathy. Material and Methods The patients diagnosed with PBPS between 2010 and 2020 who may only benefit from PPS use were included into the study after subgroup and phenotype assessment (urinary and non-ulcerative organspecific subgroups). In our study, patients who had history of degenerative maculopathy or diseases predisposing to maculopathy (age-related macular degeneration, diabetes mellitus, hypertension, chronic vascular disorders, central serous chorioretinopathy, retinal dystrophy, epiretinal membrane, and chronic exposure to hydroxychloroquine) were excluded to prevent possible misdirection. Patients underwent best-corrected visual acuity assessment using Snellen chart, anterior segment and fundus examination using slit lamp biomicroscopy, and intraocular pressure measurement. Color vision test (Ishihara test), posterior segment optical coherence examination and 10-2 visual field test were performed, and color images of the fundus and autofluorescence imaging were obtained. Best-corrected visual acuity, color vision results, macular, choroidal and mean retinal nerve fiber thicknesses, mean deviation of the visual field and fundus findings were recorded. Results Out of 15 patients included into the study, 4 (37.5%) were male and 11 (73.3%) were female. The mean age of the patients was 53.3±11.2 years. During the follow-up, the duration of oral PPS use was found to be 33.01±10.59 months, cumulative oral PPS dose to be 216.02±97.63 g and duration of diagnosis to be 66.64±39.37 months. The mean central macular thickness of the patients was measured to be 254.55±33.11 ?m, and the mean choroidal thickness to be 261.82±34.22 ?m. Mean deviation of the visual field of the patients was found to be -1.89 ±-1.25 dB. The mean retinal nerve fiber thickness was measured to be 98.1±17.62 ?m from the fundus autofluorescence images of the patients. Furthermore, in the present study, the ocular findings of the patients who are at below and above the mean cumulative dose and exposure period were compared. Conclusion This study detected no correlation between longterm PPS use and maculopathy. When forming the patient group; it is crucial to exclude patients with comorbidities such as diabetes mellitus and hypertension, and to form a homogeneous group by phenotype and subgroup assessment. Randomized, prospective, multi-center studies are needed to better assess this correlation

Different surgical techniques applied in the treatment of punctum obstruction and the retrospective evaluation of the results

Punktal stenoz, gözyaşı kanalının dış açıklığının daralması ya da tamamen tıkanması anlamına gelir. Doğuştan ya da edinsel olabilir. En sık sebebi kronik blefarittir. Enfeksiyonlar, yaşlanma, inflamasyon, topikal uygulanan ilaçlar, sistemik kemoteröpatik ilaçlar diğer sebeplerdir. Tedavide amaç yeterli punktum açıklığı sağlamak ve lakrimal pompa fonksiyonunu korumaktır. Altın standart bir tedavi yöntemi henüz yoktur. Çalışmamızda punktum stenozu nedeniyle farklı cerrahi teknikler uygulanan hastaların cerrahi öncesi ve sonrası bulguları geriye dönük incelenmiştir. Çalışmamıza 142 hastanın 259 gözü dahil edildi. Uyguladığımız cerrahi yöntemler; üçlü kesi punktoplasti, üçlü kesi punktoplasti + 5FU-MMC, mikropunch punktoplasti, mikropunch punktoplasti + 5FU-MMC, mikropunch punktoplasti + TA, bikanaliküler pigtail yardımlı silikon entübasyon, bikanaliküler pigtail yardımlı silikon entübasyon + 5FU-MMC ve punktokonjonktival flep tekniğidir. Çalışmamıza dahil edilen 142 hastanın yaş ortalaması 65,08±14,08 yıldır. Hastaların %52,1'i kadın, %47,9'u erkektir. Hastaların %82,4'üne (117 hasta) bilateral, 25 hastaya unilateral cerrahi uygulanmıştır. En sık uyguladığımız cerrahi Üçlü kesi + 5FU-MMC'dir.. Birincil işlemler sonrasında restenoz üst punktumda 18, alt punktumda 39 gözde görülmüştür. Restenoz gelişim süresi üst ve alt punktum için de en sık ilk 1 aydır. Birincil işlemler sonrasında gözlerin %76,1'inde epifora tamamen, %21,6'sında kısmen düzelmiştir. Epiforası kısmen düzelen hastalara ikincil ve üçüncül işlemler yapılmıştır. Cerrahi yöntem grupların karşılaştırıldığında üst ve alt punktum için hem anatomik hem fonksiyonel başarı açısından anlamlı bir fark görülmemiştir. Punktum stenozu epiforaya sebep olabilen farklı etyolojik faktörlerin yol açtığı bir hastalıktır. Hasta semptomatikse risk faktörleri iyi değerlendirildikten sonra uygun cerrahi planlama yapılmalıdır.Punctal stenosis refers to narrowing or complete obstruction of the external opening of the tear duct. It can be congenital or acquired. The most common cause is chronic blepharitis. Infections, aging, inflammation, topically applied drugs, systemic chemotherapeutic drugs are other causes. The aim of treatment is to provide adequate punctal opening and to preserve lacrimal pump function. There is no gold standard treatment method yet. In our study, the pre- and post-surgical findings of patients who underwent different surgical techniques for punctal stenosis were examined retrospectively. 259 eyes of 142 patients were included in our study. The surgical methods we apply; triple incision punctoplasty, triple incision punctoplasty + 5FU-MMC, micropunch punctoplasty, micropunch punctoplasty + 5FU-MMC, micropunch punctoplasty + TA, bicanalicular pigtail assisted silicone intubation, bicanalicular pigtail assisted silicone intubation + 5FU-MMC and punctoconjunctival flep technique. The mean age of 142 patients included in our study was 65,08±14,08 years. 52,1% of the patients were female and 47,9% were male. Bilateral surgery was performed in 82,4% (117 patients) of the patients and unilateral surgery was performed in 25 patients. The most frequently performed surgery is Triple incision + 5FU-MMC. After primary procedures, restenosis was seen in 18 eyes in the upper punctum and in 39 eyes in the lower punctum. Restenosis development time is most common in the first 1 month for the upper and lower punctum. After the primary procedures, the epiphora was completely resolved in 76,1% of the eyes and partially resolved in 21,6%. Secondary and tertiary procedures were performed on patients whose epiphora partially resolved. When the surgical method groups were compared, no significant difference was observed in terms of both anatomical and functional success for the upper and lower punctum. Punctal stenosis is a disease caused by different etiological factors that can cause epiphora. If the patient is symptomatic, appropriate surgical planning should be performed after the risk factors are well evaluated